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Physician assistants are key members of health care team

Physician assistants are an integral part of the health care delivery system, and it is unfortunate that the article "Non-doctors prescribe millions of painkillers," by John Fauber and Kristina Fiore, did not fairly represent their contributions (Feb. 28).

The authors offer biased commentary on physician assistants, with a clear lack of research or understanding of the level of care that PAs and other "non-doctor" providers are trained to provide. Their comment that, "The idea (of these providers) was that they could handle less complicated cases like colds and routine blood work, allowing doctors to spend more time with patients," is simply inaccurate and uninformed.

Through rigorous education — most PAs have master's degrees — and experience, PAs are trained to work in a wide variety of health care environments and practice settings. They work closely within a team of providers including a physician or group of physicians. They have education and training that allow them to make autonomous decisions and consult with a physician as appropriate.

Within their scope of practice, PAs can manage a clinic as well as lead a medical home. Their physician partners are not required to be on-site.

The article implies that PAs, among other "mid-level" providers, prescribe narcotic medication inappropriately, compared with physicians. However, no studies or statistics are referenced that compare prescribing practices of different providers. For many surgical specialty PAs working within their MD-PA team, a key responsibility for the PA is to write prescriptions for patients being discharged after surgery, as well as refilling these medications as the patient recovers from surgery. This role is simply a matter of division of duties within the team.

The physician assistant profession was founded on the concept of team practice. Working in all medical and surgical specialties, physician-PA teams enhance coordination and quality of care. As part of their team, PAs effectively enhance quality of care, access to care and coordination of care for the patients they serve.

James Ginter, PA-C

President

Wisconsin Academy of Physician Assistants

Kimberly

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Don't expose kids to Cyrus

After reading the March 5 article headlined "From tweens to twerk," I guess I shouldn't be surprised at some parents' unwillingness to say no to their children.

But I have little patience for anyone who would allow any child of 5, 8 or even 12-plus years of age to be exposed to Miley Cyrus' "performances," live or in any media format. How sad it is that little girls can no longer be little girls and are becoming sexualized at a younger and younger age. I would hardly refer to Cyrus as someone who is exhibiting self-proclaimed "feminist energy" through music and dance that easily falls into the realm of soft porn.

As a parent of three grown children, I remember well indignant tweens who sulked for days because they weren't allowed to see R-rated movies that "all the other kids" got to see. As an elementary school teacher, I frequently see the results of children's early exposure to sexual content via all forms of media.

How sad that the adults of the future have been robbed of the innocence of childhood by parents who say "yes" to poor role models and "no" to the few remaining opportunities to minimize the damage being done by a sexually pervasive media to the moral character of our children.

Beth Flehmer

Cedarburg

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Long history in Ukraine conflict

The Ukraine/Russia conflict has an ancient history that too often is not part of the conversation about what has happened this winter.

Russia long has asserted natural rights as a huge landmass that would otherwise be choked from access to seaports by local powers. Russia's military is at Crimea, one of the closest points, not the whole Black Sea, and at the end of a long, long dead-end passage — this is not Hamburg or Marseille, militarily or commercially.

This crisis occurred and took root because factions in Ukraine wanted to change history and affiliate with the European Union. Russia also wants better trade with the EU and world, as seen in the Sochi Olympics. Timing took us to this crisis, and, as Winston Churchill said, "Jaw-jaw is better than war-war." It is a good sign none have died since the street battles in Kiev.

Historically, ethnically, culturally, linguistically and economically, Ukrainians want and deserve greater freedom to make more economic decisions; to be part of the world's markets. Several options short of brutal suppression may strike mutually acceptable middle ground:

Russian-controlled land access to current assets on the Crimea Peninsula continues through a new East Ukraine semi-autonomous Russian allied zone. Kiev becomes a special economic zone at the edge of a new West Ukraine for everything but grain, with an international airport and secure recognized land access to a port at the mouth of the Dnieper River and Odessa, river barge access and continued travel terms outside Ukraine.

All three parties would need formal seasonal ongoing confidence-building meetings with accompanying festivals/trade fairs. If these matters can be incorporated into a deal that will allow return to economic vitality, they should be considered.

Gregory Francis Bird

Milwaukee

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Don't blame Obama for Russia

The talking point right now in the media is that Russian aggression is the fault of President Barack Obama's weakness in dealing with Syria. The president's reluctance to take action on Syria after it crossed his red line has given Russian President Vladimir Putin a green light to bully whomever he wants.

The hawks are everywhere, blaming Obama's inaction for emboldening Putin. It's not quite that simple. Putin knows after two wars lasting a decade that the American public has no stomach for military intervention anywhere. The reason Obama didn't use force in Syria was he did not have the support of the American people. Without public support for military action across the globe, he has depended heavily on drones and took a back seat to oust Moammar Gadhafi in Libya.

This president's hands have been tied due to a loss of resources, United States credibility and loss of public support for military action because of the failed war in Iraq. Critics would say leadership changes public opinion, and he is to blame for not convincing the American people that force is sometimes necessary. He could lie to us, scare us into backing military action and go to friendly media outlets and challenge Americans' patriotism. That was the Bush-Cheney way, and he was elected to be better than that — and he has been.

This may sound like more George W. Bush bashing, but critics warned us before going into Iraq that we might feel the repercussions for decades — and that's exactly what's happening right now.

Robert Cotter

Milwaukee

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Stop giving Obama a pass

How many free passes will President Barack Obama get when it comes to faithfully executing the laws of the United States? Regardless of one's opinion of the Affordable Care Act, for example, there is nothing in the law giving him the authority to unilaterally delay its full implementation.

If the president can do as he wills despite the Constitution and relevant statutes, then we are no longer under rule of law but under the rule of a czar. For those who look the other way due to political convenience, realize the precedent could have a severe boomerang effect.

If the president wants to delay implementation, Congress needs to pass a bill he can sign authorizing such a delay. Absent a change in the law, it should be implemented as passed.

Terry Breunig

Hartland

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Great work being done at MPS

As a master adjudicator for the Wisconsin School Music Association, I have judged many concert festivals, solo and ensemble festivals and auditions for state honors organizations at various Milwaukee schools over the past three decades. I have always been favorably impressed with the work being done by the teachers and students and by the commitment of the families.

On March 1, I again judged a solo and ensemble festival at Rufus King High School and was blown away by the high quality of most of the performances I was privileged to hear. Many of them were played totally from memory.

I am not exaggerating or sugar-coating my impression of these events in order to produce an encomium for the students and teachers of Milwaukee Public Schools. These were some truly outstanding performances on a near-professional level, and I sent many of them on to the state solo and ensemble festivals. I made it a point to ask several of the students if they took private lessons outside of school, and some did. But a large number of them said they prepared the solos on their own with help from their teachers at school. To me, this is the embodiment of the essence of the educational process.

It was also a joy to see the families assembled in the performance room to support their students. Proud parents giving hugs and fellow students giving high-fives following the performances were commonplace. They knew what they had accomplished.

For the ubiquitous and multifarious critics of the MPS, I say that one of the keys to improving the schools is right under their noses and they can't see (or hear) it. Maybe they don't want to. But I invite them to attend one of these events someday and sit in a judge's room for at least half a day and experience it for themselves.

Larry M. Sheets

Waukesha

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Population clock ticking?

In 1798, Thomas Malthus predicted that "A population will eventually outgrow the means to support itself." How close have we come to his prediction? In a 1995 book by Donald Wood, "Post-Intellectualism and The Decline of Democracy: The Failure of Reason and Responsibility in the Twentieth Century," Wood presents a population chart in which he shows that in 6000 BC the population of the world was around 10 million. It then took from 6000 BC to 1850, the start of the Industrial Revolution, to reach 1 billion people.

In only the last 165 years, we have added 6 billion more people to our planet, with around a billion living at or below the poverty line. Yet there are still industrialists and politicians who say that overpopulation and over-misuse of our natural resources are not the main causes of things such as climate change, if only because they think of nature and the environment as nothing more than an asset to be bought and sold. Therefore, they still refuse to see any consequential end in their ludicrous self-serving thought process.

Will we all eventually learn from our mistakes? Only time will tell. Unfortunately, it probably will be our children's children's children who will find out.

Mark S. Hansen

Milwaukee

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We should thank farmers

I've spent 95% of my life in Milwaukee, so it can be said that I'm a city dweller. But in my early teen years, the 1950s, my parents sent me to Marshfield to spend most of my summer vacations on my uncle's dairy farm. So I do know a bit about farming.

The American farmer does not get the credit or respect that he deserves. I believe that the American farmer could feed the whole world if need be. But, of course, that would destroy the economic structures of too many countries. So United States farmers end up getting paid not to farm some of their land. That is a product of politics and economics, not the choice of farmers.

So instead of criticizing U.S. farmers, we ought to thank them for getting the maximum from their land and herds. To my way of thinking, they moved the U.S. into the world leadership it enjoys today.

Henry Olszewski

West Allis

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Got taxes?

I was born and raised in Waukesha County when the county led in milk production. At that time, all farms were small family farms. I think the neighbors of these large industrial farms need some assistance to deal with the costs of the air, land, water and smell pollution. How about a milk cow tax?

Think about it — four legs, a tail and a big nose. Tax them all. Don't like that idea? Try this, a cow chip tax — dried or fresh. The numbers are staggering.